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A laparoscopic surgical procedure known as vagotomy involves the transection of the vagus nerves, which are critical components of the autonomic nervous system. The vagus nerve, designated as the tenth cranial nerve, originates from the brainstem and extends through the neck, thorax, and abdomen, branching out to innervate various organs, including the stomach and upper digestive tract. The primary purpose of performing a vagotomy is to reduce excessive gastric acid production, thereby aiding in the prevention of peptic ulcers. Historically, vagotomy was a common surgical intervention; however, its frequency has diminished due to the effectiveness of pharmacological treatments available for managing ulcers. During the procedure, a small incision is made in the upper abdomen, through which a trocar is inserted to establish pneumoperitoneum, allowing for the introduction of a laparoscope. Additional incisions are made to facilitate the insertion of surgical instruments. The surgeon carefully identifies the vagus nerve, ensuring it is freed from surrounding tissues. In the context of CPT® Code 43652, a selective or highly selective vagotomy is performed, distinguishing it from a truncal vagotomy, which involves the division of the main vagal trunks. Selective vagotomy entails identifying and dissecting the main vagal trunks up to the branch that leads to the biliary tree, with the goal of transecting the nerve as close to the hepatic branch as possible. Highly selective vagotomy further involves dissection to the Latarjet's nerve branches, which are divided starting at the esophagogastric junction and continuing along the lesser curvature of the stomach. Upon completion of the procedure, the surgical instruments and laparoscope are removed, air is released from the abdominal cavity, and the portal incisions are meticulously closed.
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The procedure of selective or highly selective vagotomy, as described by CPT® Code 43652, is indicated for the following conditions:
The procedure for selective or highly selective vagotomy involves several critical steps, each essential for the successful completion of the surgery:
Post-procedure care following selective or highly selective vagotomy includes monitoring the patient for any complications related to the surgery. Patients may experience some discomfort and will require pain management. Recovery time can vary, but patients are typically advised to follow a specific diet to accommodate changes in gastric function. Follow-up appointments are essential to assess healing and manage any potential complications, such as gastric stasis or changes in digestion. The healthcare team will provide detailed instructions regarding activity restrictions and dietary modifications to support recovery.
| Short Descr | LAPAROSCOPY VAGUS NERVE | Medium Descr | LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV | Long Descr | Laparoscopy, surgical; transection of vagus nerves, selective or highly selective | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Changed | Short description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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